Provider Demographics
NPI:1831497833
Name:FIELDS, POLLY FRANCES (LMFT)
Entity Type:Individual
Prefix:MS
First Name:POLLY
Middle Name:FRANCES
Last Name:FIELDS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23711 ENTWHISTLE RD E
Mailing Address - Street 2:
Mailing Address - City:BUCKLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98321-8485
Mailing Address - Country:US
Mailing Address - Phone:253-862-2163
Mailing Address - Fax:253-862-7527
Practice Address - Street 1:23711 ENTWHISTLE RD E
Practice Address - Street 2:
Practice Address - City:BUCKLEY
Practice Address - State:WA
Practice Address - Zip Code:98321-8485
Practice Address - Country:US
Practice Address - Phone:253-862-2163
Practice Address - Fax:253-862-7527
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-01
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA600179-119OtherUBI